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Start Date: /de Completion Date: <br />Misc. <br />Misc. <br />Misc. <br />CAC <br />Total $ <br />Sign )1/161 <br />Print 0.--,AeAe.kz_., r\ <br />IF THE WORK DOES NOT COMMENCE WITHIN 72 HOURS OF THE ISSUANCE <br />OF A CONTROL NUMBER, THE CONTROL NUMBER WILL BECOME INVALID <br />AND THE PERMITTEE SHALL CALL FOR A NEW CONTROL NUMBER. PRIOR TO <br />ANY REQUIRED INSPECTIONS, AS IDENTIFIED ON THE REVERSE SIDE OF THIS <br />PERMIT, PERMITTEE SHALL CALL INSPECTIONS AT (209) 937.8381. <br />READ GENERAL PROVISIONS ON THE REVERSE SIDE OF THIS PERMIT BEFORE <br />SIGNING. <br />A.5 CITY OF <br />STOCKTON <br />Applicant: ACC- <br />Address: \ \.....Orw..β€ž fn. 2,0k3 <br />State: ZIP: 153S0-A <br />E-mail: <br />Permit Number <br />to94 <br />VALID WITHOUT A <br />CONTROL IIMER. <br />CALL (209) 937-8366 TO REQUEST A CXNTROL <br />NUMBER NO LESS THAN 24 HOURS, BUT NOT NO <br />EXCESS OF 72 HOURS PRIOR TO START OF waw. <br />CONTROLO <br />Phone: ( 201)5'lq 2221 <br />ENCROACHMENT PERMIT <br />ON PUBLIC RIGHT-OF-WAY <br />I (or we) hereby apply for an Encroachment Permit to carry out the following work: <br />AViL 6&-\Or C5( VO:Y-') ()_) S6X b0(β€˜β€˜IT β€˜1,1\ ALL StA3AkC of Norlidpova <br />ba1/4. ZI-4 04 <br />UL Date: 5)25/19 <br />City: I*A-)c\42::sk.) <br />WORK LOCATION: LAU PA n <br />i <br />t)(\k-er <br />) <br />ATTENTION: Applicant/Contractor- you are responsible to replace all broken, damaged, <br />and/or raised sidewalk, curb and gutter from score mark to score mark adjacent to the <br />parcel; remove USA markings upon completion of the permitted work. <br />APPROVED: BY THE DEPARTMENT DIRECTOR <br />Subject to the General Provisions and Special Conditions, and all work must <br />conform to the project's approved Storm Water Pollution Prevention Plan or <br />the most current version of the City of Stockton Storm Water <br />Pollution Prevention aintenance Staff Guide, whichever is applicabl <br />By: ."71/ roort - .41101.4 Date: <br />Associated Permit(s): Expiration: OFFICIAL USE ONLY Show sketch or refer to attached Drawing <br />Sve A\\ <br />Base Permit Fee <br />Additional Footage Fee <br />$ <br />Special Conditions: <br />-ro 1,6 i4 PARY--#461 LANE <br />1261-1opEp ArGLCRVIINIert <br />1 <br />l C,11 <br />51-44441,A42-M (!-176 3144Le Ok. <br />CALI°. 609j 937---821-08 <br />coo-Pmex... 4u44veiz, Buq2..-to tt <br />51-04 NICiale.- <br />C.ortra.c.:r <br />Kr7FRAI <br />IMPORTANT: Applicant hereby agrees to comply with all provisions of this permit, as well as all applicable cly ordirfances, resolutions, tandards and <br />Specifications currently in effect, and to pay to the City its actual cost for removal and proper replacement of any item which does not meet the above <br />requirements. Failure to comply will be cause for revocation of this permit. Applicant agrees to indemnify and hold the City harmless against any and <br />all losses, costs, or damages resulting from injury to persons, death of person or damage to property occurring at the site of, or as a result of, work to be <br />performed under this permit. A certificate of insurance shall be on file with the City Risk Manager prior to issuance of this permit. <br />Official Use Only